Project 5: Modelling Industry Behaviour and the Use of Vaporised Nicotine Products on Population Health

PI: Dr. David Levy

Tobacco use patterns may change dramatically due to the development and marketing of new vaporised nicotine products (referred to as VNPs, which includes e-cigarettes, pressurised aerosol nicotine products, and heat no-burn tobacco products). Use of VNPs has surged, which is likely driven by the perception that they are less harmful than regular cigarettes and are useful smoking cessation aids (1-6). At the population level, however, VNP use may actually delay cessation of cigarettes among current smokers by serving as “bridge” products to avoid smoking restrictions and VNP use may attract never smokers as a gateway to later using smoked cigarettes (7-11). This complex set of circumstances combined with the many uncertainties poses extreme challenges to those responsible for developing public health policy decisions. The uptake and use of VNPs will be influenced by the regulatory context in which they are brought to market. Regulatory options range from the extremes of no regulations to complete prohibition to middle-ground alternatives such as regulating VNPs a medicine or as a special class of consumer product.

In situations such as these, modelling provides a “virtual laboratory” to synthesise existing evidence and compare the impact of different policy options on health outcomes (12) (13). In the absence of definitive evidence on the long-term health outcomes of VNPs, exploring possible scenarios under different assumptions via statistical modelling will provide the best evidence available to assess policy options to long-term impact on public health. Modelling has at least three purposes: 1) to provide a framework that integrates information from different sources to develop a comprehensive approach; 2) to combine best information from prior studies to project future trends in behaviours and associated outcomes; and 3) to consider the effect of a hypothetical set of policies before they are implemented. This project will provide a modelling-based public health framework for defining VNP and cigarette use rates and changes in use rates, and for estimating the impact of policies. Key inputs for this modelling in Project 5 will rely on the results of Projects 1-4. Further, the Project 5 modelling will also use data from other sources (e.g., the Population Assessment of Tobacco and Health (PATH) longitudinal study and FDA funded studies). The SimSmoke tobacco control policy simulation model will be applied to evaluate the population impact of exclusive and dual cigarette and VNP use. The model will consider initiation, cessation, switching and relapse rates to predict trends in use patterns, and project how the trends in use and health outcomes are affected by tobacco control policies and regulations. Models will also be developed to specifically consider industry behaviour as well as the impact of tobacco control policies and regulations on industry behaviour. The specific aims of the project are:

Aim 1: Develop a conceptual framework for predicting the impact that tobacco control policies have on VNP and smoked tobacco use rates.

Inputs and parameters will be developed in conjunction with the Project Leaders in this Program Project, and based on the relevant literature and the advice of outside expert panels.

Aim 2: Develop an economic model of tobacco industry behaviour and product regulation.

Similar to Aim 1, inputs and parameters will be developed in conjunction with the Project Leaders in this Program Project, and based on the relevant literature and the advice of outside expert panels. The model will distinguish the role of the conventional cigarette business and specialised VNP firms in the evolution of the VNP market, and consider how cigarette and VNP industry dynamics are influenced by various regulatory options.

Aim 3: Develop models that will estimate trends in VNP and cigarette use, the effects of policies on the forms of use, and health consequences.

Models would be developed for three countries with differing regulatory environments, the United States (US), England (EN), and Canada (CA), with sub aims:

• Aim 3.1: Develop models of VNP and cigarette use for each nation to consider exclusive and dual use of VNPs and cigarettes, and characterize the effect of policies directed at VNP use and policies directed at cigarette use on VNP and cigarette use.
• Aim 3.2: Use the models to examine past policies and the potential role of policies aimed at use of VNP and cigarette use. Modes will be used to examine the potential effect of policies on patterns of use and on tobacco-attributable deaths in each country and compare across counties.

Aim 4: Build comparable models for middle and low income countries, with adequate local data.

Using the previously developed SimSmoke model (Aim 3), the research team will develop models for middle and low income countries to estimate future trends in VNP and cigarette use, and to compare the role of supply vs demand-reducing policies affecting the VNP and cigarette use and associate health effects.